What is a retracted stoma?
Now, a retracted stoma is where the stoma sinks below the level of the skin instead of sitting slightly above it. As long as your stoma is still functioning normally, there's no need to panic as retraction on its own isn't dangerous. The main issue is that retracted stoma can make it harder for your flange to form a good seal against the skin, which can lead to leakage.
You need to pay an extra attention to it if you have an ileostomy or urostomy, since output from these stoma types tends to be looser and more likely to seep underneath a flange that isn't sealing properly. If you're worried that your stoma may have retracted, the best first step is to speak to your Stoma Care Nurse as a retracted stoma is pretty manageable once you have the right products and guidance in place.
What causes a retracted stoma?
Retraction doesn't usually happen overnight. It tends to develop gradually, so you may only notice it when your stoma starts to look smaller or less prominent than it used to. A few things can contribute to a stoma retracting:
- Weight gain is one of the most common causes: as the abdominal wall expands, the stoma can end up sitting lower relative to the surrounding skin, even though the stoma itself hasn't changed.
- Poor healing around the stoma site, scar tissue formation, or a lack of blood flow to the area (ischaemia) can also play a role, as can severe malnourishment or immunosuppression, which can affect how well the body heals.
In some cases, retraction is also linked to mucocutaneous separation, where the join between the stoma and the surrounding skin comes apart slightly, sometimes due to an infection or tension on the healing wound. Where a stoma was sited in a less-than-ideal spot to begin with (somewhere prone to skin creasing or friction) this can also make retraction more likely over time.
What are the signs of a retracted stoma?
The clearest sign is a stoma that looks smaller than usual or seems to have sunk closer to skin level. A healthy stoma usually sits around 2.5cm proud of the skin, so if yours looks flatter than that, it's worth keeping an eye on. Sometimes the change isn't obvious just by looking, and you might notice it instead when your usual stoma bag becomes trickier to fit properly. Increased leaking, even after applying a fresh bag, or skin around the stoma that feels sore or irritated more often than usual, can also point to retraction.
If any of this sounds familiar, don't wait it out; get in touch with your Stoma Care Nurse. They'll be able to confirm what's going on and talk you through the best next steps.
Speaking of peristomal skin, here are some respective guides for you:
What products can help with a retracted stoma?
Again, a retracted stoma is one of the “simpler” stoma complications to manage day-to-day, thanks to products designed specifically for this. The most effective option is usually a convex flange or wafer, one that curves outward rather than sitting flat. This gentle outward curve presses the skin around the stoma slightly inward which helps the stoma project more and giving the bag a much better seal against the skin. Here are some convex products for your specific care needs.
Apart from convex products, many people find a stoma seal or barrier ring useful, as it adds a bit of extra thickness and support around the base of the stoma, further improving adhesion and reducing the risk of leaks. Depending on your needs, your Stoma Care Nurse may suggest combining a convex product with a seal or ring, or trying a support belt for extra security throughout the day. Again, since everyone's stoma and skin are a little different, it's worth working with your Stoma Care Nurse to find the specific combination that fits you best, rather than assuming one product will work for everyone.
Maintaining a healthy weight can also help prevent further retraction, since additional weight gain puts more pressure on the abdominal wall around the stoma. If this applies to you, your Stoma Care Nurse can help you build a plan that supports your stoma health alongside any wider health goals.
Will I need stoma revision surgery?
For most people, a retracted stoma can be well managed with the right products and support, without any need for surgery. Stoma revision (also known as resiting) is a procedure that moves the stoma to a new position on the abdomen, and it's generally only considered when non-surgical approaches haven't resolved the issue, or when retraction is causing complications that are significantly affecting your health or quality of life.
If revision surgery is needed, it's carried out under general anaesthetic. The surgeon closes the original stoma site and creates a new one in a better location, and you'll typically stay in hospital for a few days afterwards for monitoring. Resiting doesn't mean starting from scratch with your day-to-day life as most people find they simply need a little time to adjust to the new position, including how it fits with clothing or bag placement. Your Stoma Care Nurse will support you through that adjustment.
When should you speak to a professional regarding a stoma retraction?
It's worth reaching out to your Stoma Care Nurse if your stoma appears to be shrinking or sitting lower than before, if you're leaking more frequently despite a properly fitted bag, or if the skin around your stoma is becoming increasingly sore or irritated. Getting advice early makes it much easier to find the right products and prevent skin problems before they escalate.
FAQ: Stoma retraction
What does a retracted stoma look like?
A retracted stoma sits flush with or below the level of the skin, rather than protruding slightly above it as a typical stoma does. It may look smaller than usual, and you might find your regular stoma bag doesn't fit as securely as it used to.
Is a retracted stoma dangerous?
Not usually. As long as your stoma continues to function normally, a retracted stoma isn't dangerous on its own. The main concern is that it can make it harder to get a good seal with your bag, which increases the risk of leaks and skin irritation if it isn't managed properly.
Can a retracted stoma go back to normal?
In rare cases, a stoma can return closer to its original position over time, but this isn't the norm. Most retracted stomas are managed long-term with the right products, such as a convex appliance, rather than fully reversing on their own.
Do I need surgery for a retracted stoma?
Not usually. Most people manage a retracted stoma successfully with convex products, seals, or barrier rings recommended by their Stoma Care Nurse. Surgery (stoma revision) is generally only considered if non-surgical options haven't worked or the retraction is causing significant complications.